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Development of a person-centered conceptual model of perceived fatigability

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Abstract

Purpose

Perceived fatigability, reflective of changes in fatigue intensity in the context of activity, has emerged as a potentially important clinical outcome and quality of life indicator. Unfortunately, the nature of perceived fatigability is not well characterized. The aim of this study is to define the characteristics of fatigability through the development of a conceptual model informed by input from key stakeholders who experience fatigability, including the general population, individuals with multiple sclerosis (MS), and individuals with fibromyalgia (FM).

Methods

Thirteen focus groups were conducted with 101 participants; five groups with n = 44 individuals representing the general population, four groups with n = 26 individuals with MS, and four groups with n = 31 individuals with FM. Focus group data were qualitatively analyzed to identify major themes in the participants’ characterizations of perceived fatigability.

Results

Seven major themes were identified: general fatigability, physical fatigability, mental fatigability, emotional fatigability, moderators of fatigability, proactive and reactive behaviors, and temporal aspects of fatigability. Relative to those in the general sample, FM or MS groups more often described experiencing fatigue as a result of cognitive activity, use of proactive behaviors to manage fatigability, and sensory stimulation as exacerbating fatigability.

Conclusions

Fatigability is the complex and dynamic process of the development of physical, mental, and/or emotional fatigue. Trait- and state-like biological, psychological, social, and environmental moderators contribute to tremendous variability in fatigability (both between and within-person variability). Future research to further characterize fatigability across populations, test treatments for fatigability, and develop new measures of this construct are greatly needed.

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Funding

Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number R21AG053186; PI: Kratz. Dr. Kratz was supported during manuscript preparation by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (Award Number K01AR064275). The U-M Pepper Center, which is funded by the National Institute of Aging (Award Number AG024824), provided assistance with subject recruitment. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA

    Anna L. Kratz, Shubhangi Kulkarni, Jenna Russell & Noelle E. Carlozzi

  2. Department of Physical Medicine and Rehabilitation, University of Michigan; VA Ann Arbor Health Care System GRECC, Ann Arbor, MI, USA

    Susan L. Murphy

  3. Department of Neurology, University of Michigan, Ann Arbor, MI, USA

    Tiffany J. Braley

  4. University of Glasgow, Glasgow, Scotland, UK

    Neil Basu

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  1. Anna L. Kratz
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  2. Susan L. Murphy
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  5. Shubhangi Kulkarni
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Correspondence to Anna L. Kratz.

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Kratz, A.L., Murphy, S.L., Braley, T.J. et al. Development of a person-centered conceptual model of perceived fatigability. Qual Life Res 28, 1337–1347 (2019). https://doi.org/10.1007/s11136-018-2093-z

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